Dynamic eye fixation for retinal imaging

ABSTRACT

A retinal imaging system includes an eyepiece lens assembly, an image sensor, a dynamic fixation target viewable through the eyepiece lens assembly, and a controller coupled to the image sensor and the dynamic fixation target. The controller includes logic that causes the retinal imaging system to perform operations including: acquiring a first image of the eye, analyzing the first image to determine whether a misalignment between the eye and the eyepiece lens assembly is present; in response to determining the misalignment is present, adjusting a visual position of the dynamic fixation target to encourage the eye to rotate in a direction that compensates for the misalignment, and acquiring the retinal image of the eye after adjusting the visual position of the dynamic fixation target.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.16/584,606, filed Sep. 26, 2019, which claims the benefit of U.S.Provisional Application No. 62/753,570, filed on Oct. 31, 2018, thecontents both of which are incorporated herein by reference.

TECHNICAL FIELD

This disclosure relates generally to retinal imaging technologies, andin particular but not exclusively, relates to fixation targets forretinal imaging.

BACKGROUND INFORMATION

Retinal imaging is a part of basic eye exams for screening, fielddiagnosis, and progress monitoring of many retinal diseases. A highfidelity retinal image is important for accurate screening, diagnosis,and monitoring. Bright illumination of the posterior interior surface ofthe eye (i.e., retina) through the pupil improves image fidelity butoften creates optical aberrations or image artifacts, such as cornealreflections, iris reflections, or lens flare, if the retinal camera andillumination source are not adequately aligned with the eye. Simplyincreasing the brightness of the illumination does not overcome theseproblems, but rather makes the optical artifacts more pronounced, whichundermines the goal of improving image fidelity.

Accordingly, camera alignment is very important, particularly withconventional retinal cameras, which typically have a very limited eyeboxdue to the need to block the deleterious image artifacts listed above.The eyebox for a retinal camera is a three dimensional region in spacetypically defined relative to an eyepiece of the retinal camera andwithin which the center of a pupil or cornea of the eye should reside toacquire an acceptable image of the retina. The small size ofconventional eyeboxes makes retinal camera alignment difficult andpatient interactions during the alignment process often strained.

Various solutions have been proposed to alleviate the alignment problem.For example, moving/motorized stages that automatically adjust theretina-camera alignment have been proposed. However, these stages tendto be mechanically complex and substantially drive up the cost of aretinal imaging platform. An effective and low cost solution forefficiently and easily achieving eyebox alignment of a retinal camerawould improve the operation of retinal cameras.

BRIEF DESCRIPTION OF THE DRAWINGS

Non-limiting and non-exhaustive embodiments of the invention aredescribed with reference to the following figures, wherein likereference numerals refer to like parts throughout the various viewsunless otherwise specified. Not all instances of an element arenecessarily labeled so as not to clutter the drawings where appropriate.The drawings are not necessarily to scale, emphasis instead being placedupon illustrating the principles being described.

FIG. 1 illustrates a retinal image including an demonstrative imageartifact due to misalignment of the retinal camera.

FIG. 2 illustrates a retinal imaging system with a dynamic fixationtarget, in accordance with an embodiment of the disclosure.

FIG. 3 is a cross-sectional diagram of an eye illustrating how a lateraloffset results in reduced image quality of a retinal image.

FIG. 4 is a cross-sectional diagram of an eye illustrating how rollingof an eye shifts the cornea, iris, and crystalline lens of the eyeresulting in a lateral decentering from the optical axis of a retinalimaging system, in accordance with an embodiment of the disclosure.

FIG. 5 is a cross-sectional diagram of an eye illustrating how arotation of the eye can compensate for a lateral offset, in accordancewith an embodiment of the disclosure.

FIGS. 6A and 6B are charts illustrating how the optical transferfunction for different fields of view and anatomical planes is improvedby a rotation to compensate for a lateral offset, in accordance with anembodiment of the disclosure.

FIG. 7 is a chart illustrating how an eye rotation that compensates fora lateral offset improves image contrast along both center and edge raytraces through the imaging path, in accordance with an embodiment of thedisclosure.

FIG. 8A is a cross-sectional diagram of an eye illustrating how a wellaligned eye rejects corneal reflections from entering the imaging path,in accordance with an embodiment of the disclosure.

FIG. 8B is a cross-sectional diagram of an eye illustrating how alateral offset between the eye and the retinal imaging system results incorneal reflections deleteriously entering the imaging path, inaccordance with an embodiment of the disclosure.

FIG. 8C is a cross-sectional diagram of an eye illustrating how an eyerotation compensates for the lateral offset resulting in cornealreflections again being rejected from entering the imaging path, inaccordance with an embodiment of the disclosure.

FIG. 9 is a flow chart illustrating a process of operating a retinalimaging system with a dynamic fixation target to encourage eye rotationsthat compensate for lateral offsets, in accordance with an embodiment ofthe disclosure.

DETAILED DESCRIPTION

Embodiments of an apparatus, system, and method of operation fordynamically adjusting a fixation target of a retinal camera system toencourage a compensating eye roll maneuver that offsets lateralmisalignment between the retinal camera system and an eye are describedherein. In the following description numerous specific details are setforth to provide a thorough understanding of the embodiments. Oneskilled in the relevant art will recognize, however, that the techniquesdescribed herein can be practiced without one or more of the specificdetails, or with other methods, components, materials, etc. In otherinstances, well-known structures, materials, or operations are not shownor described in detail to avoid obscuring certain aspects.

Reference throughout this specification to “one embodiment” or “anembodiment” means that a particular feature, structure, orcharacteristic described in connection with the embodiment is includedin at least one embodiment of the present invention. Thus, theappearances of the phrases “in one embodiment” or “in an embodiment” invarious places throughout this specification are not necessarily allreferring to the same embodiment. Furthermore, the particular features,structures, or characteristics may be combined in any suitable manner inone or more embodiments.

High fidelity retinal images are important for screening, diagnosing,and monitoring many retinal diseases. To this end, reducing oreliminating instances of image artifacts that occlude, or otherwisemalign portions of the retinal image is desirable. FIG. 1 illustrates anexample retinal image 100 with multiple image artifacts 105. These imageartifacts may arise when misalignment between the retinal imaging systemand the eye permit stray light and deleterious reflections from theillumination source to enter the imaging path and ultimately arecaptured by the image sensor with the retinal image light. Misalignmentcan lead to deleterious corneal/iris reflections, refractive scatteringfrom the crystalline lens, occlusion of the imaging aperture, opticalaberrations due to off axis passage through the crystalline lens, theblockage of imaging light by the iris, and/or other issues.

Conventional imaging systems have relatively small eyeboxes, whichrequire precise alignment to avoid image artifacts from entering theimage path. Embodiments described herein utilize a dynamic fixationtarget not just as a static point to stabilize a patient's fixation,select the center ray of the patient's field of view (FOV), and lock thepatient accommodation at a fixed depth, but also to aid in the alignmentand retinal image optimization. In particular, embodiments describedherein incorporate a dynamic fixation target that moves in real-timebased upon retinal image quality and/or eye tracking to encourage thepatient's eye to roll in a direction that compensates for a lateralmisalignment (decentering) between the eyepiece of the retinal imagingsystem and the patient's eye. The dynamic adjustment of the fixationtarget expands the eyebox without the use of complicated or costlymechanical components. The expanded eyebox eases the alignment burdenwhile reducing the instances of image artifacts/aberrations that malignthe captured retinal image.

The dynamic adjustment of the fixation target may be used during apreview phase and motivated to achieve pre-retinal-imaging alignmentbetween the user's eye and the eyepiece. The dynamic adjustments to thefixation target may also be motivated to achieve multiple alignmentarrangements that move the position of an image artifact 105 betweenretinal images or between bursts of retinal images. It is typicallydesirable to move an image artifact 105 entirely out of the FOV of theimage sensor when reasonably possible. However, in some instances an eyemovement that achieves 100% removal of an image artifact 105 from theimaging FOV isn't readily or easily achievable. In such instances, thedynamic fixation target may be moved to encourage the patient's eye toroll in specified directions. Although the image artifact 105 may not beentirely removed from all or any of the multiple retinal images, thepatient's eye is directed to roll in such a manner that each portion ofthe retina is clearly imaged in at least one retinal image. The multipleretinal images may then be combined or stacked to entirely remove imageartifacts 105 from a composite retinal image.

FIG. 2 illustrates a retinal imaging system 200 with a dynamic fixationtarget, in accordance with an embodiment of the disclosure. Theillustrated embodiment of retinal imaging system 200 includes anilluminator 205, an image sensor 210 (also referred to as a retinalimage sensor), a controller 215, a user interface 220, a display 225, analignment tracking camera(s) 230, and an optical relay system. Theillustrated embodiment of the optical relay system includes lensassemblies 235, 240, 245 and a beam splitter 250. The illustratedembodiment of illuminator 205 comprises a ring illuminator with a centeraperture 255.

The optical relay system serves to direct (e.g., pass or reflect)illumination light 280 output from illuminator 205 along an illuminationpath through the pupil of eye 270 to illuminate retina 275 while alsodirecting image light 285 of retina 275 (i.e., the retinal image) alongan imaging path to image sensor 210. Image light 285 is formed by thescattered reflection of illumination light 280 off of retina 275. In theillustrated embodiment, the optical relay system further includes beamsplitter 250, which passes at least a portion of image light 285 toimage sensor 210 while also optically coupling dynamic fixation target291 to eyepiece lens assembly 235 and directing display light 290 outputfrom display 225 to eye 270. Beam splitter 250 may be implemented as apolarized beam splitter, a non-polarized beam splitter (e.g., 90%transmissive and 10% reflective, 50/50 beam splitter, etc.), a dichroicbeam splitter, or otherwise. The optical relay system includes a numberof lenses, such as lenses 235, 240, and 245, to focus the various lightpaths as needed. For example, lens 235 may include one or more lensingelements that collectively form an eyepiece lens assembly that isdisplaced from the cornea of eye 270 by an eye relief 295 duringoperation. Lens 240 may include one or more lens elements for bringimage light 285 to a focus on image sensor 210. Lens 245 may include oneor more lens elements for focusing display light 290. It should beappreciated that optical relay system may be implemented with a numberand variety of optical elements (e.g., lenses, reflective surfaces,diffractive surfaces, etc.) and may vary from the configurationillustrated in FIG. 2.

In one embodiment, display light 290 output from display 225 representsa dynamic fixation target. The dynamic fixation target may be an imageof a plus-sign, a bullseye, a cross, a target, or other shape (e.g., seedemonstrative dynamic fixation target images 291). The dynamic fixationtarget not only can aid with obtaining alignment between retinal imagingsystem 200 and eye 270 by providing visual feedback to the patient, butmay also give the patient a fixation target upon which the patient canaccommodate and stabilize their vision. The dynamic fixation target maybe moved by translating the image of the fixation target about display225 as desired (e.g., moving the fixation target up/down or left/righton display 225). Display 225 may be implemented with a variety oftechnologies including an liquid crystal display (LCD), light emittingdiodes (LEDs), various illuminated shapes (e.g., an illuminated cross orconcentric circles), or otherwise. Of course, the dynamic fixationtarget may be implemented in other manners than a virtual image on adisplay. For example, the dynamic fixation target may be a physicalobject (e.g., crosshairs, etc.) that is physically manipulated.

Controller 215 is coupled to image sensor 210, display 225, illuminator205, and alignment tracking camera 230 to choreograph their operation.Controller 215 may include software/firmware logic executing on amicrocontroller, hardware logic (e.g., application specific integratedcircuit, field programmable gate array, etc.), or a combination ofsoftware and hardware logic. Although FIG. 2 illustrates controller 215as a distinct functional element, the logical functions performed bycontroller 215 may be decentralized across a number hardware elements.Controller 115 may further include input/output (I/O ports),communication systems, or otherwise. Controller 215 is coupled to userinterface 220 to receive user input and provide user control overretinal imaging system 200. User interface 220 may include one or morebuttons, dials, feedback displays, indicator lights, etc.

Image sensor 210 may be implemented using a variety of imagingtechnologies, such as complementary metal-oxide-semiconductor (CMOS)image sensors, charged-coupled device (CCD) image sensors, or otherwise.In one embodiment, image sensor 210 includes an onboard memory buffer orattached memory to store/buffer retinal images.

Alignment tracking camera 230 is an optional element that operates totrack lateral alignment (or misalignment) between retinal imaging system200 and eye 270, and in particular, between eyepiece lens assembly 235and eye 270. Alignment tracking camera 230 may operate using a varietyof different techniques to track the relative position of eye 270 toretinal imaging system 200 including pupil tracking, retina tracking,iris tracking, or otherwise. In the illustrated embodiment, alignmenttracking camera 230 includes two cameras disposed on either side ofeyepiece lens assembly 235 to enable triangulation and obtain X, Y, andZ position information about the pupil or iris. In one embodiment,alignment tracking camera 230 includes one or more infrared (IR)emitters to track eye 270 via IR light while retinal images are acquiredwith visible spectrum light. In such an embodiment, IR filters may bepositioned within the image path to filter the IR tracking light. Insome embodiments, the tracking illumination is temporally offset fromimage acquisition.

As discussed below in greater detail, lateral alignment may be measuredvia retinal images acquired by image sensor 210, orseparately/additionally, by alignment tracking camera 230. In theillustrated embodiment, alignment tracking camera 230 is positionedexternally to view eye 270 from outside of eyepiece lens assembly 235.In other embodiments, alignment tracking camera 230 may be opticallycoupled via the optical relay components to view and track eye 270through eyepiece lens assembly 235.

During operation, controller 115 operates illuminator 205 and retinalimage sensor 210 to capture one or more retinal images. Illuminationlight 280 is directed through the pupil of eye 270 to illuminate retina275. The scattered reflections from retina 275 are directed back alongthe image path through aperture 255 to image sensor 210. When eye 270 isproperly aligned within the eyebox of system 200, aperture 255 operatesto block deleterious reflections and light scattering that wouldotherwise malign the retinal image while passing the image light itself.Prior to capturing the retinal image, controller 215 operates display225 to output a fixation target to guide the patient's gaze. One or moreinitial eye images (a.k.a., initial alignment images), either from imagesensor 210 or alignment tracking camera 230, are acquired and analyzedto determine the lateral alignment between eye 270 and eyepiece lensassembly 235. These initial alignment images may be illuminated withinfrared (IR) light output from illuminator 205 (or an independentilluminator associated with alignment tracking camera 230) so as not totrigger an iris constriction response, which constricts the imaging pathto retina 275. In other embodiments, conventional white light or otherchromatic light is used to acquire the initial alignment images. Theinitial alignment image is then analyzed by controller 215 to identifyany misalignment, reposition the dynamic fixation target to encourage ancompensating eye rotation, and then acquire one or more subsequent eyeimages (e.g., retinal images) with image sensor 210. The subsequentimages may be full color images, specific chromatic images, or even IRimages as desired.

FIG. 3 is a cross-sectional diagram of eye 270 illustrating how alateral offset results in reduced image quality of a retinal image. Wheneye 270 is slightly misaligned from the ideal centered location in the Xor Y direction (decenter 301), a shift of chief ray 305 occurs due tooff center imaging through crystalline lens 310. FIG. 3 depicts a Yshift of 2 mm with a 4 mm diameter pupil 315. The dashed rays representthe center FOV while the solid rays represent the edge of the imageplane in a 45 degree retinal image. As illustrated, pupil 315 of theiris blocks some imaging rays. The current fixation is at nominalfixation causing the user to accommodate to the target, as well ascenter their eye on the target. The depicted lateral offset ordecentered/misalignment reduces the amount of light transmitted to theretina and creates aberrations due to the shifting of chief ray 305 andoff-center imaging through crystalline lens 310 and cornea 405.

FIG. 4 is a cross-sectional diagram of eye 270 illustrating how rotationof eye 270 shifts the cornea 405, pupil 315, and crystalline lens 310resulting in a lateral decentering from the optical axis 410 of retinalimaging system 200. FIG. 4 depicts a 0 mm Y shift but also a 15 degreeeye rotation. As illustrated, the rotation axis of eye 270 is not atcornea 405, but roughly about the center of the eyeball. This causescornea 405, pupil 315, and crystalline lens 310 to shift forming alateral decenter from the optical axis. While usually this is anundesired effect, this effect can also be leveraged to compensate for alateral offset or misalignment between retinal imaging system 200 andeye 270.

FIG. 5 is a cross-sectional diagram of eye 270 illustrating how arotation of eye 270 towards the direction of lateral offset 301 cancompensate for the lateral offset, in accordance with an embodiment ofthe disclosure. FIG. 5 illustrates a 2 mm Y offset (offset 301) betweeneye 270 and the center optical axis through eyepiece lens assembly 235along with a compensating 5 degrees of eye rotation towards thedirection of offset. In other words, eye 270 is laterally offset 2 mmabove the center of eyepiece lens assembly 235 and thus rotates down(i.e., towards the direction of the lateral offset) to compensate forthe decentered misalignment.

Referring to the uncompensated situation illustrated in FIG. 3, due toaberrations in cornea 405 and crystalline lens 310, the retinal imagequality suffers from the lateral misalignment. However, as discussedabove, the compensating rotation illustrated in FIG. 5 compensates forthis loss in image quality. FIG. 6A illustrates an optical transferfunction (OTF) plot 605 corresponding to the uncompensated lateraloffset scenario illustrated in FIG. 3. The various lines represent OTFvs spatial frequency for different FOVs and the sagittal vs tangentialplanes. FIG. 6B illustrates an OTF plot 610 corresponding to thecompensated lateral offset scenario illustrated in FIG. 5. As can beseen from plots 605 and 610, the 5 degree compensating rotation of eye270 increases the OTF for all lines on plot 610, particularly the bottomlines, which represent the most off axis ray traces in the image path.The compensating rotation improves the OTF by moving the image path rayscloser to the center of eye 270. Furthermore, the ray bundle size inFIG. 5 passing through pupil 315 to the retina is larger than thatillustrated in FIG. 3, and therefore increases the retinal imagebrightness.

FIG. 7 is a chart 700 illustrating how an eye rotation that compensatesfor a lateral offset also improves image contrast along both center andedge ray traces through the image path, in accordance with an embodimentof the disclosure. Line 701 represents a center ray without acompensating eye roll, while line 702 represents that same center raywith a compensating eye roll. As can be seen, the compensating effectincreases with greater lateral offset of eye 270 from the center ofeyepiece lens assembly 235. Similarly, line 703 represents an edge FOVray without a compensating eye roll, while line 704 represents that sameedge FOV ray with a compensating eye roll. Again, the compensatingeffect increases with greater lateral offset of eye 270 from the centerof eyepiece lens assembly 235.

FIGS. 8A-C illustrate how a compensatory roll of eye 270 towards thedirection of a lateral offset also improves rejection of deleteriouscorneal reflections, in accordance with embodiments of the application.FIG. 8A illustrates an example where the center optical axis 805 of eye270 is aligned with the center optical axis 810 of eyepiece lensassembly 235. With appropriate alignment between eye 270 and eyepiecelens assembly 235, deleterious corneal reflections 815 are separatedfrom and directed away from imaging path 820. FIG. 8B illustrates a 1.5mm lateral offset without any compensating eye roll. As can be seen,corneal reflections 815 enter into the imaging path 820, which malignthe overall retinal image. FIG. 8C illustrates a 1.5 mm lateral offsetwith a compensating roll or tilt of eye 270 towards the direction ofoffset (in this case a tilt up). As illustrated, corneal reflections 815are once again rejected and directed outside the imaging path 820.Additionally, a greater percentage of the incident light passes throughpupil 315 of the iris to the retina resulting in a brighter retinalimage.

FIG. 9 is a flow chart illustrating a process 900 for operation ofretinal imaging system 200, in accordance with an embodiment of thedisclosure. The order in which some or all of the process blocks appearin process 900 should not be deemed limiting. Rather, one of ordinaryskill in the art having the benefit of the present disclosure willunderstand that some of the process blocks may be executed in a varietyof orders not illustrated, or even in parallel.

In a process block 905, the retinal imaging process is initiated.Initiation may include the user selecting a power button from userinterface 220. In a process block 910, an initial eye image is acquiredwith dynamic fixation target located at an initial or default position(e.g., center of display 225). The initial eye image is then analyzed bycontroller 215 (process block 915) to determine lateral alignmentbetween eye 270 and eyepiece lens assembly 235. In one embodiment, theinitial eye image is a retinal image acquired with image sensor 210through eyepiece lens assembly 235. The retinal image may be analyzed toidentify the characteristic presence of corneal reflections that arisedue to a lateral misalignment between retinal imaging system 200 and eye270. The presence and location of the corneal reflections in the initialretinal image can be correlated (e.g., via a lookup table) to adetermined lateral offset. The corneal reflections can be correlated toboth direction and magnitude of the lateral misalignment. In oneembodiment, these correlations can arise due to illuminator 205including a plurality of discrete illumination sources disposed atdifferent radial and/or angular positions about aperture 255. Eachdiscrete illumination source gives rise to a different characteristicreflection depending upon alignment/misalignment of system 200 with eye270. Alternatively (or additionally), the initial retinal image may beanalyzed by comparing image qualities (e.g., contrast levels, etc.)between different regions of the retinal image, and these image qualityvariations correlated to lateral misalignment (direction and magnitude).As described in connection with FIGS. 6A, 6B, and 7, edge FOV imagingrays are affected differently than center FOV imaging rays by lateralmisalignment. This difference can be exploited and correlated todetermine the direction and magnitude of a lateral misalignment betweenretinal imaging system 200 and eye 270.

In another embodiment, the initial eye image is captured by alignmenttracking camera 230, which is a separate and distinct camera fromretinal image sensor 210. Alignment tracking camera 230 images theexterior of eye 270 to perform pupil or iris tracking. Alignmenttracking camera 230 may be positioned external to eyepiece lens assembly235 to acquire the pupillary image or iris image outside of imaging path285 (illustrated), or optically coupled into the imaging path 285 toimage eye 270 through eyepiece lens assembly 235 (not illustrated).Again, the pupillary image or iris image can be used with eye trackingtechniques to determine the relative position of eye 270 to retinalimaging system 200 during a preview phase. In other words, the pupillaryimage or iris image can be analyzed and correlated to the direction andmagnitude of a lateral misalignment. In one embodiment, the initialimage may be acquired using IR illumination, so as not to elicit an iriscontraction during the previous phase prior to acquiring the regularretinal images. In other embodiments, other chromatic or broad-spectrumflash illumination may be used.

After the magnitude of a lateral misalignment has been determined, thatlateral misalignment is compared against a threshold misalignment value(decision block 920). In one embodiment, the threshold misalignmentmagnitude is selected to be 1 mm; however, other threshold misalignmentvalues either greater or smaller may be selected. In one embodiment, thethreshold misalignment value may be selected to be any value greaterthan zero. If the determined lateral misalignment is determined to beless than the threshold misalignment value (decision block 920), thenprocess 900 continues to process block 935 where the subsequent retinalimage (or burst of retinal images) are acquired with image sensor 210.

However, if the determined lateral misalignment is determined to begreater than the threshold misalignment (decision block 920), thenprocess 900 continues to a process block 925 where a visual position ofthe dynamic fixation target is adjusted (e.g., repositioned on display225, physically moving display 225, intervening optics used to change aperceived position, etc.). In process block 925, the direction of therepositioning and the magnitude of the repositioning of the dynamicfixation target is based upon and correlated to the direction of thelateral misalignment and the magnitude of the lateral misalignmentcalculated in process 915. In one embodiment, a lookup table may be usedto correlate the analyzed characteristics of the initial eye image todirection and magnitude of adjustments to the position of the dynamicfixation target on display 225.

As discussed above, the dynamic fixation target provides a visual cue toeye 270 upon which the patient can fixate. As such, a repositioning ofthe dynamic fixation target while otherwise holding retinal imagingsystem 200 steady relative to the patient's head, encourages eye 270 torotate. By selecting the amount and direction of this repositioning,dynamic fixation target encourages eye 270 to roll towards the directionof lateral offset to compensate for the lateral misalignment.Furthermore, this repositioning of the dynamic fixation target may alsobe motivated to move one or more image artifacts 105 to differentpositions. The repositioning may be executed during a pre-view phase toobtain a desired alignment, at which point one or more retinal imagesare acquired in process block 935. Alternatively, the repositioning maybe executed between successive retinal images or between bursts ofretinal images for image stacking. The determination of thresholdalignment or threshold misalignment includes alignments thatadvantageously reposition image artifacts 105 to achieve artifact freeimages of certain portions (or all portions) of the retina.

The dynamic fixation target may be repositioned to a new temporary fixedlocation or continuously repositioned in a pattern (decision block 930).In the embodiment where the dynamic fixation target is repositioned to anew temporary fixed location, process 900 continues to a process block935 where the retinal image is acquired by image sensor 210.Accordingly, the retinal image is acquired while the eye is encouragedto rotate, after the eye has been encouraged to rotate, or as the eye isencouraged to rotate. In a decision block 940, the retinal image may beanalyzed to determine whether its quality is acceptable (or whether agiven image artifact was sufficiently moved away from a certainposition), and if so, it is stored (process block 945). If the retinalimage includes unacceptable defects (e.g., greater than thresholdlateral misalignment still present) or if one or more image artifactsstill need to be repositioned to achieve sufficient imaging coverage ofthe retina, then process 900 loops back to process 910 and repeats. Inembodiments that analyze the retinal image in process block 915 todetermine alignment, process 900 may alternatively loop back to processblock 915 and reanalyze the retinal image acquired in process block 935for readjustments to the position of the dynamic fixation target.Storing of the retinal image(s) in process block 945 may includecombining or stacking multiple retinal images into a single compositeretinal image that is free of image artifacts or at least sufficientlyfree of image artifacts in the region or regions of interest.

Returning to decision block 930, in place of repositioning the dynamicfixation target to temporary fixed locations, the dynamic fixationtarget may be continuously moved in a repeating pattern (e.g., a circle,oval, back-and-forth jitter, etc.) that encourages the eye to sweepthrough the direction that compensates for the lateral misalignment(process block 950). Image acquisition may be synchronized with thesweeping motion of eye 270 and acquired in process block 935. In oneembodiment, image sensor 210 acquires a burst of retinal images duringthe illumination flash time as eye 270 sweeps through the gaze directionthat compensates for the lateral misalignment. The burst images can thenbe analyzed to identify which image has the best image quality (i.e.,acquired at the optimal compensating position).

The processes explained above are described in terms of computersoftware and hardware. The techniques described may constitutemachine-executable instructions embodied within a tangible ornon-transitory machine (e.g., computer) readable storage medium, thatwhen executed by a machine will cause the machine to perform theoperations described. Additionally, the processes may be embodied withinhardware, such as an application specific integrated circuit (“ASIC”) orotherwise.

A tangible machine-readable storage medium includes any mechanism thatprovides (i.e., stores) information in a non-transitory form accessibleby a machine (e.g., a computer, network device, personal digitalassistant, manufacturing tool, any device with a set of one or moreprocessors, etc.). For example, a machine-readable storage mediumincludes recordable/non-recordable media (e.g., read only memory (ROM),random access memory (RAM), magnetic disk storage media, optical storagemedia, flash memory devices, etc.).

The above description of illustrated embodiments of the invention,including what is described in the Abstract, is not intended to beexhaustive or to limit the invention to the precise forms disclosed.While specific embodiments of, and examples for, the invention aredescribed herein for illustrative purposes, various modifications arepossible within the scope of the invention, as those skilled in therelevant art will recognize.

These modifications can be made to the invention in light of the abovedetailed description. The terms used in the following claims should notbe construed to limit the invention to the specific embodimentsdisclosed in the specification. Rather, the scope of the invention is tobe determined entirely by the following claims, which are to beconstrued in accordance with established doctrines of claiminterpretation.

What is claimed is:
 1. A retinal imaging system, comprising: an eyepiecelens assembly; an image sensor adapted to acquire a retinal image of aneye through the eyepiece lens assembly; a dynamic fixation targetoptically coupled to the eyepiece lens assembly such that the dynamicfixation target is viewable through the eyepiece lens assembly; and acontroller communicatively coupled to the image sensor and the dynamicfixation target, the controller including logic that when executed bythe controller causes the retinal imaging system to perform operationsincluding: acquiring a first image of the eye; analyzing the first imageto determine if a misalignment is present between the eye and theeyepiece lens; in response to determining the misalignment is present,adjusting a visual position of the dynamic fixation target to encouragea user to move the eye in a direction that compensates for themisalignment; and acquiring the retinal image of the eye after adjustingthe visual position of the dynamic fixation target.
 2. The retinalimaging system of claim 1, wherein the retinal image comprises a secondretinal image and wherein the first image of the eye comprises a firstretinal image acquired with the image sensor.
 3. The retinal imagingsystem of claim 2, wherein analyzing the first image to determine if themisalignment is present comprises: comparing image qualities betweendifferent regions of the first retinal image.
 4. The retinal imagingsystem of claim 2, wherein analyzing the first image to determine if themisalignment is present comprises: analyzing the first retinal image fora presence of one or more corneal reflections; and correlating the oneor more corneal reflections to a lateral decentered position of the eyerelative to the eyepiece lens assembly.
 5. The retinal imaging system ofclaim 1, further comprising: an alignment tracking cameracommunicatively coupled to the controller and disposed to capture imagesof a pupil or an iris of the eye, and wherein the first image of the eyecomprises a pupillary image or an iris image.
 6. The retinal imagingsystem of claim 5, wherein analyzing the first image to determine if themisalignment is present comprises: correlating the pupillary image orthe iris image to a lateral decentered position of the eye relative tothe eyepiece lens assembly.
 7. The retinal imaging system of claim 1,further comprising: an illuminator communicatively coupled to thecontroller and positioned to illuminate the eye with infrared (IR) lightwhile acquiring the first image, wherein the first image comprises an IRimage of the eye to reduce iris contraction prior to acquiring theretinal image.
 8. The retinal imaging system of claim 1, whereinadjusting the visual position of the dynamic fixation target comprises:adjusting the visual position of the dynamic fixation target toencourage the eye to rotate towards the direction of the misalignment;and adjusting the visual position of the dynamic fixation target by anamount correlated to a magnitude of the misalignment.
 9. The retinalimaging system of claim 1, wherein the dynamic fixation target comprisesa virtual fixation target generated by a display optically coupled withthe eyepiece lens assembly to display the virtual fixation targetthrough the eyepiece lens assembly.
 10. The retinal imaging system ofclaim 1, wherein adjusting the visual position of the dynamic fixationtarget comprises: continuously adjusting the visual position of thedynamic fixation target in a repeating pattern that encourages the eyeto sweep through the direction that compensates for the misalignment;and synchronizing the acquiring of the retinal image with thecontinuously adjusting of the visual position of the dynamic fixationtarget to acquire the retinal image when the eye is moved to compensatefor the misalignment.
 11. A method of imaging a retina with a retinalimaging system, the method comprising: displaying a dynamic fixationtarget at an initial visual position; acquiring a first image of an eyewith the dynamic fixation target at the initial visual position;analyzing the first image to determine whether a misalignment, that isgreater than a threshold misalignment, is present between the eye and aneyepiece lens assembly of the retinal imaging system; in response todetermining the misalignment is present, adjusting the dynamic fixationtarget to a revised visual position that encourages the eye to move in adirection that compensates for the misalignment; and acquiring a secondimage of the eye while the dynamic fixation target is at the revisedvisual position, wherein the second image comprises a retinal image. 12.The method of claim 11, wherein the retinal image comprises a secondretinal image and the first image of the eye comprises a first retinalimage acquired with a retinal image sensor imaging through the eyepiecelens assembly.
 13. The method of claim 12, wherein analyzing the firstimage to determine whether the misalignment is present comprises:comparing image qualities between different regions of the first retinalimage.
 14. The method of claim 12, wherein analyzing the first image todetermine whether the misalignment is present comprises: analyzing thefirst retinal image for a presence of one or more corneal reflections;and correlating the one or more corneal reflections to a lateraldecentered position of the eye relative to the eyepiece lens assembly.15. The method of claim 11, wherein the first image of the eye comprisesa pupillary image or an iris image captured with a eye tracking camerathat is separate and distinct from a retinal image sensor used tocapture the retinal image.
 16. The method of claim 15, wherein analyzingthe first image to determine whether the misalignment is presentcomprises: correlating the pupillary image or the iris image to alateral decentered position of the eye relative to the eyepiece lensassembly.
 17. The method of claim 11, further comprising: illuminatingthe eye with infrared (IR) light while capturing the first image as anIR image of the eye to reduce iris contraction prior to acquiring thesecond image.
 18. The method of claim 11, wherein adjusting the dynamicfixation target to the revised visual position that encourages the eyeto move in the direction that compensates for the misalignmentcomprises: adjusting the dynamic fixation target to encourage the eye tomove towards the direction of the misalignment; and adjusting thedynamic fixation target by an amount correlated to a magnitude of themisalignment.
 19. The method of claim 11, wherein displaying the dynamicfixation target comprises generating a virtual fixation target with adisplay optically coupled with the eyepiece lens assembly to output thevirtual fixation target through the eyepiece lens assembly.
 20. Themethod of claim 11, wherein adjusting the dynamic fixation target to therevised visual position that encourages the eye to move in the directionthat compensates for the misalignment comprises: continuously moving thedynamic fixation target in a repeating pattern that encourages the eyeto sweep through the direction that compensates for the misalignment.